How significant is reduction of adipocyte apoptotic death?

[tony montana]

The April PRS featured the following article on the subject of adipocyte apoptotic death reduction:

Autologous Lipofilling: Coenzyme Q10 Can Rescue Adipocytes from
Stress-Induced Apoptotic Death

You may see it in the atachments below:



At first it seemed to me like a significant finding on behalf of these scientists, however, checked with my mentor and mentor says that there are no noticeable post lipofilling changes even two to three years afterwards.

So what does everyone think is the signficance if any, or the application of this finding? Thanks

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[Moravian]

The April PRS featured the following article on the subject of adipocyte apoptotic death reduction:

Autologous Lipofilling: Coenzyme Q10 Can Rescue Adipocytes from
Stress-Induced Apoptotic Death

At first it seemed to me like a significant finding on behalf of these scientists, however, checked with my mentor and mentor says that there are no noticeable post lipofilling changes even two to three years afterwards.

So what does everyone think is the signficance if any, or the application of this finding? Thanks

There is some general disagreement concerning fat grafting among plastic surgeons, and this really becomes evident at the meetings. If you read some back issues of PRS, you'll find all sorts of articles, techniques and opinions. Not everyone gets the same results, and not everyone believes the results some people show. Since I'm early in my plastics career, I'll relate what I've been told and leave my opinion out since I'm sure someone will disagree with it.

Preparation of the fat is a hot topic. Some centrifuge, some don't, some use this cannula, some use that one. A very nice paper titled,"An Experimental Model for Improving Fat Graft Viability and Purity,"
in the April 15 PRS, 119(5):1571-1583, shows a techique that gives a very high purity of viable cells. It's just that no one is sure whether this is important. I'm looking forward to their next paper using the adipocytes in grafting. One would think that the preparation and viability of fat cells, and the stress placed on the cells, would be essential to survival. We'll have to wait and see.

Where you inject seems to have a bearing on survivability (although, like I said, there is no consenssus on this as well). In areas that are more moble, like the face, the grafts don't seem to "take" as well, whereas there has been number of articles lately on injecting the breast with good results.

Then there is all the stuff about pluripotent adipocytes, directed differentiation, etc. What all this says is that there is more going on than we currently understand. I think your article in question, while certainly not a scientific breakthrough, adds another piece to the knowledge base. It remains to be seen if the piece will be a relevant one.

--M

 

[tony montana]

Hey Moravian -


I appreciate your reply. It clarified a good number of doubts I had. I think I get a sense of how most people feel about the effect on survival of all these variations of technique.

I wonder, however, is there any way to tell if fat cells are lost post graft. Is it common to see, for example, a "loss" in volume of the graft?

You mention that in movable areas, the grafts don't seem to take as well. How is this evidenced?

I am trying to understand the practical value of determining whether doing it one way or the other is better.

If there is no visible evidence (on the gluts, face, etc) of fat cell apoptosis, why bother trying to increase their survival? I hope that makes sense. Thanks in advance.


TM

 

[Moravian]

There is a loss of volume which either signifies cell death/apoptosis, injection of nonviable cells, atrophy of liveing cells or some other process. This is especially apparent in areas like the nasolabial lines and the lips. Note that I gave a list of reasons for decreased "take" because I don't think anyone knows for sure what happens.

Interestingly, there are reports of increased breast size in women who had fat grafts and then gained weight. It makes some sense in that the fat must be stored somewhere. Somehwat congruent, there was also a recent report on increased breast size after abdominal liposuction. And, since the breast has a lot of fat, (especially breasts in older women), maybe the injected fat survives better because of the local environment.

So, we don't know what role initial cell viability plays, but I suspect we'll know soon enough the direction the research seems to be going. There is also a whole bunch of new stuff on adipocyte metabolism, second messengers, local chemokines and the like. It's an exciting field for a lot of reasons, including the possiblity of adipocytes for wound healing, muscle repair, a source of stem cells, stc.

Hope this helps,

--M

 

[MOHS_01]

The experience in the dermatology literature has been fairly consistent for the past decade or so -- like Dr. M states, fat transfer with successful take varies depending upon recipient site. We tell patients to expect about a 30-40% take per session, sometimes more, sometimes less, depending on the patient. There is a fair amount of disagreement regarding the best donor sites, best way to harvest and handle the fat, storage, etc...

We also tell ladies that they should expect up to a cup increase in breast size following liposuction to areas elsewhere. Presumably this due to loss of fat cells in the areas undergoing liposuction, with preferential deposition in unaltered areas, simply a reflection of relative adipocyte density. I do not believe that this has been studied extensively enough to say for certain, however.

Don't shoot the dermie who posts here...I have way more respect for PS than most, and defer to them the vast majority of the time.

 

[Moravian]

We also tell ladies that they should expect up to a cup increase in breast size following liposuction to areas elsewhere. Presumably this due to loss of fat cells in the areas undergoing liposuction, with preferential deposition in unaltered areas, simply a reflection of relative adipocyte density.

There was a recent paper in PRS (119(5):1584-1589, April 15, 2007) that, while not an exemplary study, showed that the redistribution of fat to the breasts after liposuction did not occur as robustly after abdominoplasty alone. Go figure. Other than this, our Derm colleague is correct. It has not been extensively studied which means no one really knows what's going on.

Thanks Mohs_01. We don't shoot dermatologists 'round here.

--M